Provider Demographics
NPI:1962445981
Name:GLENN, CHRISTINE M (ARNP FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:GLENN
Suffix:
Gender:F
Credentials:ARNP FNP-C
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1401 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2426
Mailing Address - Country:US
Mailing Address - Phone:504-842-4747
Mailing Address - Fax:504-842-4942
Practice Address - Street 1:1171 GATEWOOD DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-1817
Practice Address - Country:US
Practice Address - Phone:334-821-2708
Practice Address - Fax:334-528-5420
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07600363LF0000X
FL3089432363LF0000X
AL1-079387363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07681261Medicaid
LA2368583Medicaid
LA2368583Medicaid